Brainscape's Knowledge GenomeTM


Top Flashcards (Certified)
All Flashcards

Med Year 3 > Bowel Cancer and Acute Abdomen > Flashcards

Bowel Cancer and Acute Abdomen Flashcards

(66 cards)

Start Studying
1
Q

what are some causes of fresh blood in stools?

A 
haemorrhoids 
acute anal fissures
colorectal neoplasms
acute proctitis 
IBD
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

what causes black stools or malaena?

A

bleeding from further up the GI tract, including small intestine or stomach

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

what are some risk factors for colorectal cancer?

A

family history
previous cancers
IBD
red meat and low fibres

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

where are the cancers most common?

A

2/3 in colon and rest in rectum
more left colon than right
recto-sigmoid colon most frequent site

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

what are the symptoms of bowel cancer?

A 
change in bowel habit
weight loss
PR bleeding
tenesmus 
IDA = TWO WEEK WAIT
bowel obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

when would you give a two week wait for CRC

A

> 6week change in bowel habit AND pr bleeding any age
change in BH >6 weeks and age >60
RB without any other symptoms and >60

palpable mass right sided or rectal any age
IDA any age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

what investigations can you do for CRC

A

colonoscopy - first line and biopsy
barium enema
CT colonography (in patients less fit for colonoscopy)
CT TAP for metastasis in patients with weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

what is screening like in the UK for CRC?

A

Faecal immunochemical test: every 2 years to people age 60-74
faecal occult blood test

THEN colonoscopy

also - flexible cystoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

what is a polyp?

A

growth of tissue from a mucous membrane off a surface

benign or malignant, can become malignant
hyperplastic = completely benign

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

what is the dukes classification?

A

A - only mucosa and part of bowel wall - 90% prognosis
B - extending through muscle of bowel wall - 70-80%
C - lymph node involvement 50%
D - metastatic 5-10%

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

what other staging is used in CRC?

A

TNM staging - refer to notes

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

what are the treatment options for CRC?

A

surgical resection
chemotherapy
radiotherapy
palliation

polypectomy for prevention

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

what is FAP and how is it treated?

A

familial adenoma polyptosis - polyps in whole colon which will develop into cancer
total colectomy with ileo-anal pouch

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

what is the genetics of FAP

A

mutation in Apc gene - TSG

95% penetrance, CRC in 20-30s

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

what is hNPCC?

A

hereditary non-polyposis colon cancer
autosomal dominant
inherited mismatch repair genes

  • 70% penetrance, 30-50s age range, rapid progression and highly aggressive
  • use amsterdam criteria to exclude FAP
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

what are the types of surgical resection for CRC?

A

right hemicolectomy - tumours in caecam, ascending and proximal colon

left hemi-colectomy - tumours of distal transverse and descending colon

sigmoid colectomy - tumours of sigmoid colon

anterior resection - tumours of low SC or higher rectum

abdominoperineal resection - tumours of lower rectum; remove rectum and anus and suturing over, leaving them with permanent colostomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

what does a surgical resection involve?

A

removing a tumour and creating an end to end anastomosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

what is a covering loop ileostomy

A

temporary ileostomy to protect distal anastomosis
let it heal for 6-8 weeks tgeb reverse

loop: 2 ends of a section of small bowel being brought out onto skin (look for diagram)

lower right side of abdomen

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

what are complications of surgical resections for CRC?

A 
bleeding 
infection
pain
damage to nerves, ureter, bladder etc
anaesthetic risks 
anastomosis leak 
stoma?
failure
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

what are the follow ups for curative resections?

A

CT TAP at 1 and 2 and 3 years
Colonoscopy at 1 and 5 years
CEA every 6 months for 3 years

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

what is CEA?

A

carcinoembryonic antigen
tumour marker blood test for bowel cancer
useful to predict relapse of prev treated CRC

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

what is diverticular disease

A

outpouching of the colonic mucosa and submucosa through WEAKNESS in the outer muscle layers

  • commonest site is sigmoid colon due to pressure effects: chronic constipation and accumulation of faecal matter
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

what is diverticulosis?

A

presence of diverticula without symptoms
common as people age

no treatment

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

what is diverticulitis and what are the symptoms?

A

inflammation of the pouches/diverticula

  • left iliac fossa pain and tenderness
  • fever
  • diarrhoe
  • may have RB and mucus in stools
  • nausea and vomiting
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
how do you manage diverticulitis?
``` admission if unwell or haemodynamically unstable antibiotics analgesia fluid resuscitation surgical resection ? ```
26
what are the complications of diverticular disease?
bleeding infection ---> diverticulitis perforation; faeces leaking leading to peritonitis abscess formation FISTULA from colon to bladder: increase susceptibility to UTIs obstruction
27
how do you explain diverticular disease to patients
wear and tear of the bowel
28
what are the RF for diverticular disease
``` high intake red meat freq use of laxatives chronic constipation and low fibre hereditary factors age ```
29
what are the investigations you should do for diverticulitis?
FBC for infection and anaemia U&E's for CT contrast, electrolyte imbalance due to diarrhoea CRP for inflammation ABG for metabolic acidosis or alkalosis lactate for sepsis in severe cases blood cultures to rule out gastroenteritis imaging: CT AP with contrast
30
what is an acute abdomen?
condition of severe abdominal pain, usually requiring emergency surgery caused by acute disease of or injury to internal organs
31
what causes abdominal pain over the whole abdomen?
perforated viscous acute pancreatitis medical causes like DKA
32
what causes RUQ pain?
biliary colic acute cholecystitis acute cholangitis
33
what causes LUQ pain?
acute pancreatitis spontaneous splenic rupture medical disorders eg pneumonia
34
what causes right iliac fossa pain?
``` acute appendicitis diverticulitis (less likely in right) ectopic pregnancy ovarian cyst crohn's ```
35
what causes epigastric pain?
pancreatitis peptic ulcer disease AAA
36
what causes central umbilical pain?
``` AAA early appendicitis intestinal obstruction ischaemic colitis mesenteric thrombosis - in elderly ```
37
what causes left iliac fossa pain?
diverticulitis constipation ectopic pregnancy ovarian cyst
38
what causes suprapubic pain?
acute urinary retention pelvic inflammatory disease UTI ectopic pregnancy
39
what causes loin to groin pain?
renal colic AAA pyelonephritis
40
what are some classical signs of acute abdomen?
``` fever low grade tenderness rigidity and guarding rebound tenderness bowel sounds: - absent in peritonitis - increased in small bowel obstruction ``` abdo distension
41
what investigations would you do for an acute abdomen?
``` FBC U&E for CT contrast LFTs CRP amylase INR: synthetic function of liver, coagulation before theatre ABG: PO2 and calcium for acute pancreatitis lactate: tissue ischaemia abdo xray for bowel obstruction erect CXR for bubble under diaphragm USS abdo: gall stones, biliary duct dilatation and gynae CT ```
42
how do you manage an acute abdomen?
``` ABCDE nil by mouth IV access IV fluids analgesia and anti-emetics NG tube if vomiting and suspected obstruction catheterise for fluid balance monitoring escalate care ```
43
what is peritonitis
inflammation of peritoneum localised: cause: underlying organ inflammation generaliseD: perforation of abdo organ eg ulcer/appendix spontaneous bacterial: infection of ascites in cirrhotic liver disease
44
what are some other symptoms of peritonitis and how do you treat it?
guarding rebound tenderness minimal bowel sounds - laparotomy
45
what is a hernia?
structure that passes through space or defect into an abnormal location
46
how do you describe a hernia?
reducible irreducible obstructed (bowel lumen is no longer open) strangulated - compression around hernia preventing BF to bowel lumen
47
how does a hernia present?
painless swelling may be asymptomatic or pain when coughing, change in bowel habits, constipation, scrotal swelling
48
what is an inguinal hernia, how is it caused and treated?
protrusion of abdominal contents emerging through superficial ring as an exit caused by weakening of muscles/increased intra-abdominal pressure so eg chronic cough, constipation, heavy lifting treated via open or laparoscopic reduce hernial contents back into cavity and put mesh that strengthens wall
49
what is a femoral hernia
just below inguinal ligament, abdo contents pass through weakening in femoral canal higher risk of strangulation
50
what are the other types of hernias?
- umbilical | - incisional: near or on surgical site
51
what is a hiatus hernia
herniation of stomach through opening in diaphragm (LES) herniation causes contents to reflux up oesophagus and give reflux symptoms treatment: medical management of symptoms or surgical
52
what are direct inguinal hernias
pierces posterior wall, doesn't go through deep ring and then exits through superficial
53
what are indirect inguinal hernias?
does not pierce posterior wall, passes through deep inguinal ring then into inguinal canal and exits superficial ring
54
how do you tell on examination the difference between indirect and direct
put finger over deep inguinal ring = can control indirect but not direct
55
what is bowel obstruction
mechanical blockage of intestinal contents = gross dilatation of proximal bowel secretions of large volumes of electrolyte rich fluid into bowel
56
what are the types of bowel obstruction?
functional or paralytic ileus = when bowel not mechanically blocked but inflammation / electrolyte imbalance/ surgery means not working properly closed loop: second obstruction proximally sugrical emergency
57
what causes bowel obstruction?
small bowel - adhesions and hernia large - malignancy and diverticular disease intraluminal: gallstone ileus, ingested foreign body mural: obstruction from bowel wall eg cancer, strictures, DD extramural: outside of bowel causing obstruction by narrowing lumen eg hernia
58
what are the cardinal features of BO?
``` Abdominal pain colicky vomiting abdo distension absolute constipation (Early in distal and late in proximal obst) ```
59
what are the clinical features of BO?
guarding and rebound tenderness - NONE | tympanic sound or tinkling bowel sounds on percussion and auscultation
60
what are the differentials for obstructed bowel disease?
toxic megacolon | constipation
61
how do you test for BO?
bloods for electryolytes and third space losses venous blood gas bc evaluate signs of ischaemia CT contrast AP AXR erect CXR to assess for free air under diaphragm
62
what is small bowel obstruction
dilated bowel >3cm central valvulae conniventes visible
63
what is large bowel obstruction?
dilated bowel >6cm peripheral location haustral lines visible
64
how do you treat BO?
fluid resusc catheter surgical if necessary conservative: drip and suck = nil by mouth, insert NG tube IV fluids and correct electrolytes
65
what is the surgical intervention for BO?
resection
66
what are the complications of bowel obstruction
bowel ischaemia bowel perforation dehydration and renal impariment

Med Year 3 (25 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2025 Bold Learning Solutions. Terms and Conditions